In recent years, a noticeable rise in weight loss surgeries can be attributed to insurance coverage, as embodied in the story of Dr. Ratul Pal from Kolkata. After long suffering from weight-related health issues and complications from obesity, he underwent bariatric surgery in October 2024, which was completely covered by his insurance worth Rs 4.5 lakh. Following the surgery, not only did he shed substantial weight from 116 kg to around 98 kg, but he also experienced significant improvements in his knee condition and overall health.
The increase in bariatric surgeries is evident, with a surge in patients seeking help for morbid obesity—defined as having a BMI of 40 or higher. Doctors report that patients have risen from an average of 55-60 annually in 2020 to 90 at Indraprastha Apollo Hospitals in Delhi. Gaurav Shrivastav, a financial adviser, anticipates that inclusion in health insurance plans could benefit up to 38% of rural residents and about 30% in urban areas.
For insurance coverage, patients must be at least 18 and meet specific BMI criteria, showcasing Class III Obesity or Class II with co-morbidities. However, cosmetic surgeries and those resulting from psychiatric issues are not covered. There is a push from medical professionals, like Dr. Sandeep Aggarwal, to lower eligibility thresholds, citing excessive waiting periods that prevent many potential candidates from receiving timely treatment.
Claims tend to be lengthy and complex, as demonstrated by Dr. Pal’s experience. Patients often contend with a waiting period and substantial back-and-forth communication between their surgeons and insurance companies. Dr. Aggarwal noted that in some cases, insurance policies delay or impose lengthy waiting times, complicating the claims.
Obstacles arise, including stringent eligibility criteria requiring documented prior weight loss attempts and consultations. Insurers may impose additional age restrictions and require pre-authorisation, prolonging the process if documentation is missing or incorrect. Despite these challenges, gradual changes abound as more patients regain health and insurers begin to reduce barriers to treatment.
The rise in weight loss surgeries is linked to insurance coverage, as illustrated by Dr. Ratul Pal’s successful surgery funded by his insurance. Despite the surge in patients, challenges such as lengthy approval processes, stringent eligibility criteria, and insurance company scrutiny persist, complicating access to necessary treatments.
In conclusion, the landscape of weight loss surgery is evolving favourably due to expanding insurance coverage, though significant hurdles remain. Patients like Dr. Ratul Pal highlight the success possible through these procedures, yet the cumbersome insurance claims process can impede timely access. With growing awareness and modifications from insurers, it is hopeful that the barriers faced will diminish, allowing more individuals to pursue life-enhancing surgeries effectively.
Original Source: indianexpress.com
